Mariah Woodson, a 30-year-old business owner in Los Angeles, started battling eczema (also known as atopic dermatitis) at the age of 20. “I kid you not — my hands and neck looked like they belonged on a crocodile!” she recalled. “I always (jokingly) said that if a man were to ever propose to me with my hands looking like this, he would run away. And run away fast.”

Intimacy during a flare-up, she said, is challenging. “Many people do not understand that eczema is not contagious, and I was concerned about being judged for having terrible-looking skin,” said Woodson. Because of this insecurity, she turned down many dates and often avoided intimacy. “Just the thought of my skin bleeding or oozing during an intimate moment made me cringe,” she revealed.

According to one study, more than 80% of patients with atopic dermatitis (AD) said having an eczema flare-up got in the way of their sex life. For people who deal with this condition, it’s such a roadblock to intimacy that there are even dating sites, like Derma Cupid, dedicated to pairing people with skin conditions. “Eczema impacts relationships significantly because these people avoid intimacy [because they’re embarrassed],” explained Dr. Elizabeth Liotta, a board-certified dermatologist and member of HealthyWomen’s Women’s Health Advisory Council.

A mood killer in the bedroom

Eczema can lead to red, scaly and itchy patches of skin that can pop up all over a person’s body, from their hands to their neck and legs. Women can even get vulvar dermatitis, where the skin folds around the vagina also become painful, red and itchy. This can lead to physical discomfort during intercourse and emotional feelings of insecurity.

“It’s probably uncomfortable because their skin is a little bit inflamed and atopic dermatitis gets worse when it’s rubbed,” explained Liotta. Of the above study’s participants, 12% reported eczema around the genital area. And of those respondents, 59% deemed it the most distressing part of dealing with atopic dermatitis. “With anything that’s involving the genitals, obviously there are a lot more problems with anxiety and difficulties with sexual intimacy,” Liotta said.

Vulvar dermatitis can look like other skin conditions, such as psoriasis; a yeast infection; or inflammation from skin-to-skin friction, known as intertrigo, and this can sometimes lead to a delay in care. “If someone goes to their primary care doctor, they may end up with the wrong treatment, like treating for yeast infection when it’s actually a chafing thing, or treating for intertrigo when they actually have psoriasis or atopic dermatitis,” Liotta said. And then there is the fear that a new sexual partner may mistake eczema as a contagious sexually transmitted disease.

Eczema often has a tremendous impact on one’s emotional state. Research has shown a link between students with eczema being bullied, as well as their skin condition causing a decrease in self-esteem and self-confidence. These feelings can carry over into adulthood, making someone extremely self-conscious about how their skin may be perceived by others. This can lead to the embarrassment of having a potential romantic partner see their skin when undergoing a flare-up. “If you’re scratching all the time and your skin’s red and open, that’s going to be a factor for people feeling uncomfortable meeting someone new or having their skin exposed to someone,” Liotta said.

Additional dating preparations

iStock.com/andresr

Dating for those with AD can involve a lot of extra preparation. People with eczema often go to extreme lengths to prevent and hide their condition. “This can include avoiding perfumes and fragrances; wearing loose clothing, as opposed to clothing perceived as sexier; and using makeup to try and hide their eczema,” said Liotta.” Red and scaly skin isn’t always easy to cover with makeup. For instance, Liotta said attempting to put powder on eczema may just make the skin more noticeably flaky. Thus, these patients will often have to splurge for more expensive products, like liquid-based mineral makeup.

“And they also probably need to change out their makeup a bit more frequently because these patients are a little more prone to getting skin infections,” Liotta added. It’s a lot of extra steps to take before going out for a date or enjoying an evening with friends.

Treatment is key

For those with eczema, a key part of maintaining a healthy romantic and sex life is seeking out the right treatment and management protocol. For Woodson, finding skin emollients that helped alleviate her symptoms has helped tremendously. Her experience even inspired her to start her own line of skincare products designed for people facing similar flare-ups.

Lifestyle changes, like avoiding known triggers and keeping skin clean and moisturized, can help. And there are prescription drugs, including pills and injectable treatments, that Liotta said can often help patients have fewer flare-ups and may help some people spend less time actively troubleshooting the disease. “The important thing for patients to realize is that just because they have this [condition] doesn’t mean that they have to live like that [constantly troubleshooting their disease]. Their skin can look normal again with therapy, and they can have a normal, fulfilling sex life — and they don’t have to worry as much about what’s going on in the private area,” Liotta said.

Woodson eventually learned to speak up about what she was going through. “Being open and honest with a partner about the severity of my flare-ups before intimacy occurs helps me feel more comfortable and less embarrassed,” she explained. “As challenging as eczema can be, I always try and tell myself that I am beautiful, flare-up and all.” Her advice to others with eczema is to speak up and be honest about what you are feeling. “Communicate your needs and find a partner who is understanding and willing to travel on that journey with you.”

This resource has been created with support from Pfizer, Regeneron and Sanofi.